Between August 2008 and June 2012, 17 TEVAR procedures for thoracic aortic aneurysms (TAA) requiring Z2 coverage were performed at our institution. Patient age ranged from 46 to 82 years old (mean 69.4), 16 were male. Criteria for LSA revascularization at our institution are defined as either : 1) dominant left vertebral artery (VA), 2) absent or diminutive or occluded right VA, 3) no communication of bilateral VA, 4) bilateral carotid artery disease, 5) patent LIMA-coronary bypass, 6) if a long length of the thoracic aorta is covered. Devices utilized were Gore TAG (n=12) and TX2 (n=5). Deployment of the stent-graft (SG) was successful in 17 cases (100%) and complete thrombosis of the aneurysm or complete entry closure was achieved in 16 cases (94.1%). Axillo-axillar cross over bypass (Ax-Ax B) was performed in 5 cases (29.4%). There was no instance of cerebrospinal ischemia or hospital death and the mean follow-up was 22.9 month (range 5 to 46). One case was converted to open surgery due to secondary type 1 endoleak. There was no instance of Ax-Ax B graft occlusion or aneurysmal rupture. The initial and mid-term results of TEVAR requiring Z2 coverage were satisfactory, and we believe that our criteria for LSA revascularization played an important role in providing the satisfactory results.

The purpose of this study was to investigate the effects of combined resistance training and aerobic training with protein intake after resistance training on body composition in obese middle-aged women. The subjects were 42 middle-aged women (age : 56.5±4.3 years, BMI : 26.6±2.3 kg/m²), who were classified into three supplementation groups: Protein group (PG), Isocalorie placebo group (IG), and Noncalorie placebo group (CG) by Double Blind Randomized Trial. The training program consisted of combined resistance training and aerobic training for 10 weeks, 5 times per week: twice a week in a university training room and 3 times per week at home. The subjects took the nutrient supplement immediately after each resistance training session. We measured body weight (Bw), body fat volume (Bf) by bioelectrical impedance analysis (BIA), and cross-sectional area (CSA) of muscle of the thigh extensor group (Te), flexor group (Tf), and psoas major (Pm) by magnetic resonance imaging (MRI) before and after the 10-week training period. Irrespective of group, Bw and Bf showed a significant decrease after the training period compared to before (p<0.001), and the CSA of Te muscle showed a significant increase after the training period (p<0.01). Moreover, the interaction of time×group was accepted in the CSA of Pm muscle (p<0.05), and the increase in muscle volume for PG was the highest increase among the three supplementation groups (p<0.05)(PG : 2.1±0.8 cm², IG : 1.3±1.0 cm², CG : 1.3±0.9 cm²). These results suggest that combined training in middle-aged obese women improves body composition, and resistance training with protein intake may increase the CSA of muscle of psoas major.

Recoarctation, systemic hypertension, aortic aneurysm and intracranial aneurysm are generally observed within a certain period after the surgical procedure for aortic coarctation, which is known as a systemic diseases caused by not only morphological abnormalities but also arterial functional abnormalities of artery. Here, we report a case who showed complications of recoarctation, hypertension and subarachnoid hemorrhage after surgery for aortic coarctation. A 17-year-old boy originally presented to our hospital with upper extremity systemic hypertension. Recoarctation after surgery for aortic coarctation was diagnosed in his childhood, following which hypertension was followed while he received continuous treatment with anti-hypertensive drugs. He was hospitalized with sudden headache and loss of consciousness. Since subarachnoid hemorrhage was diagnosed by computed tomography, clipping of intracranial aneurysms was performed. After the clipping procedure, he underwent percutaneous intravascular stenting angioplasty. However, the pressure gradient remained and sufficient dilatation was not obtained because of the hypoplastic anatomical distal aortic arch (from the left internal carotid artery to the site of recoarctation) due to the development of collateral circulation with rib notch. At age 21, extra-anatomical bypass (from the ascending aorta to the descending aorta) was performed because of persistent upper extremity systemic hypertension. However, systemic hypertension continued to require antihypertensive medication.

We reporte the initial results of open stent-grafting (OSG) applied with a Matsui-Kitamura (MK) stent in the treatment of thoracic aortic aneurysm (TAA). From August 2005 to March 2011, OSG for TAA was applied in 35 cases (male/female, 29/6, 58∼86 years old, mean age 71). During deep hypothermic circulatory arrest with antegrade selective cerebral perfusion, the stent graft was delivered through the transected proximal aortic arch, followed by arch replacement with a 4-branched prosthesis. Concomitant procedures included 1 coronary artery bypass graft, 1 mitral valve replacement and 2 pacemaker implantations. Operative mortality within 30 days was 5.7% (respiratory failure in 1 and ischemic enteritis in 1). There was 1 in-hospital death due to brain stem infarction. Perioperative morbidity included 2 (5.7%) stroke, 5 (14.3%) spinal cord injuries (paraplegia in 1, paraparesis in 1 and transient paraparesis in 3) , and 1 (2.9%) temporary hemodialysis. Ten patients (28.6%) were intubated for more than 72 h. There was no complication with the graft-related incident. These initial results suggested the OSG method applied with a MK stent is a useful surgical procedure for the treatment of TAA.

Aortoiliac occlusive disease (AIOD) can be difficult to treat. We performed aorto-uni-iliac (AUI) stent-grafting with external-iliac artery crossover bypass in 3 cases of extensive AIOD (mean age 69 years). Lesions were TASC II type D in 2 and D+A in 1. Mean ankle-brachial index of diseased side was 0.52. Bare stent placement for iliac stenosis was also done in 2 cases. All cases were a technical success with no complications. Mean operation time was 123 min and mean hospital stay was 11 days. We have been keeping good patency. We consider it an effective treatment option for AIOD.

We report a case of operations using a hybrid technique for repeated extensive aortic aneurysm. A 71-year-old man had extensives aneurysms of the aortic arch and descending aorta. In the first operation, he had undergone thoracoabdominal aortic replacement with island repair for thoracoabdominal aortic aneurysm (Crawford type 3) at age 64. Six years later, computed tomography showed an aortic aneurysm around the region of the island repair and penetrating atherosclerotic ulcer (PAU). Therefore, he underwent abdominal debranching and thoracic endovascular aortic repair (TEVAR) at 70 years old. At the same time, he had an extensive aortic arch aneurysm. Considering the complicated surgical history and the affected region, we judged that conventional graft replacement was difficult. So, in the third operation, we performed TEVAR for the descending aorta at 71 years old. One month later, total arch replacement (TAR) with a frozen elephant trunk (FET) was performed (4th operation). The patient was discharged home 22 days after the 4th operation. This strategy of operations using hybrid techniques for extensive aortic aneurysm may be useful in high risk cases of surgical procedures and postoperative complications.

Objective: We examined complications of the downstream aorta after the frozen elephant trunk (FET) procedure. Methods: Complications were diagnosed in eight patients: true aneurysm alone in five patients; type A aortic dissection in two patients; and both true aneurysm and type B aortic dissection in one patient. Results: Elective surgery was performed in seven patients. Five patients received a Matsui-Kitamura stent graft (MKS) and three patients received a J Graft Open Stent Graft (JGOSG). The FET procedure was successfully applied in all cases. Over the long term, dilatation of the descending thoracic aorta (dTA) alone was identified in two patients and dilatation of the dTA and migration was identified in three patients using the MKS. Complications of graft kinking and migration were seen in one patient and distal stent graft-induced new entry in two patients using the JGOSG. Thoracic aortic stent graft repair was successfully performed for complications in seven patients. Conclusion: For the improvement of clinical results, FET devices need to offer flexibility and appropriate radial force.

We report on a case of a distal aortic arch aneurysm with severe shaggy aorta treated by two-stage hybrid surgery without complications. The patient was a 67-year-old man. The thoracic aortic aneurysm was identified on computed tomography imaging by his treating physician during routine follow-up for lung cancer. The patient was referred to our hospital for further investigation and treatment. The aneurysm had a maximum diameter of 68 mm with severe shaggy aorta. Based on these findings, the risk of cerebral infarction and spinal cord ischemia was considered very high. The patient underwent total arch replacement with elephant trunk, using a brain isolation technique for this initial surgery. The postoperative course was uneventful and thoracic endovascular aortic repair（TEVAR) was performed 26 days after the initial surgery. The patient was discharged on post-operative day 38, without complications.